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Table 2 Examples of theoretical reasons for disinvestment

From: Sustainability in Health care by Allocating Resources Effectively (SHARE) 2: identifying opportunities for disinvestment in a local healthcare setting

Reasons for disinvestment

Considerations

Unsafe or harmful (Absolute)

â–ª Definitions or operational criteria not provided

â–ª Emergency/major safety problems are already addressed through alerts and recalls, no definition or criteria for lower-level safety issues

Less safe (Relative)

â–ª Higher rate of the same adverse events

â–ª Other adverse events which are thought to be worse (but no guidance/criteria for comparison)

Clinically ineffective (Absolute)

â–ª No or very low health gain

â–ª No medical indication eg cosmetic procedure

Less clinically effective (Relative)

â–ª Lower rate of the same positive outcomes

â–ª Other positive outcomes thought to be less desirable (but no guidance/criteria for comparison)

Cost ineffective (Absolute)

â–ª Considers effectiveness and cost

â–ª Requires threshold, no definition or criteria provided

Less cost-effective (Relative)

â–ª Provides less health gain for their cost than alternative

â–ª No definition or criteria provided

Outdated, superseded, obsolete

â–ª Inferior to more recently introduced TCPs

â–ª No definition or criteria provided

External factors

Political decisions, local priorities, rationalisation, organisational capacity and capability